A 70-year-old woman, whose personal history included a breast cancer operated 14 years earlier, came to the emergency room of another hospital due to intense pain in the lower lip accompanied by a meningeal swelling and swelling in the lip.
She was initially treated with intravenous corticosteroids and analgesia, and was referred to her home.
A few days later, the patient arrived at the emergency room of our hospital, when she described that the needed for isolation had returned.
The lesion was painless and had no fever or other accompanying symptoms.
In the interview, the patient reported having seen spiders recently in her house.
This picture was contextualized in an epidemic of Loxosceles spider bites in the same geographical area.
In the previous 15 days, 7 cases of bites in the upper and lower limbs had been diagnosed in the emergency department.
On examination, a single 2 cm lesion was observed, with a necrotic and well-defined appearance, occupying the lateral third of the skin, vermilion and a halo surrounded by the left lower hemilabio.
Intraoral examination revealed a pale mucosal lesion with signs of necrosis and fibrinous exudate that was not detached from scraping.
Laboratory tests were requested, biopsy was taken and treatment with amoxicillin/clavulanic acid was established.
The suspected spider bite was consulted with the infectious diseases service.
The differential diagnosis was made with necrotic cutaneous-mucosal lesions, such as vasculitis, diabetic ulcers, vascular ulcers, drug reactions, thermal or chemical burns, infectious or traumatic, which were discarded.
Seven days later, a debridement of necrotic tissue was performed under local anesthesia.
The suggestive clinic and the epidemiological context, together with laboratory results and pathology and differential diagnosis led to the probable diagnosis.
Two months later, due to the limited aesthetic and functional repercussion of the gastrointestinal defect, lip reconstruction was not necessary.
